Tissue visualization and modification device

ABSTRACT

Aspects of the invention include minimally invasive imaging system. Systems according to embodiments of the invention include: an access device having a proximal end and distal end and an internal passageway extending from the proximal to distal end; and an elongated member dimensioned to be slidably moved through the internal passageway of the access device and having a proximal and distal end. In the systems of the invention, at least one of multiple visualization elements and multiple illumination elements are positioned among the distal ends of the access device and the elongated member. Also provided are methods of using the systems in imaging applications, as well as kits for performing the methods.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/739,664, filed Jan. 11, 2013, which is a continuation of U.S. patentapplication Ser. No. 12/269,770, filed Nov. 12, 2008. The contents ofthe aforementioned applications is hereby incorporated by reference intheir entireties as if fully set forth herein. The benefit of priorityto the foregoing applications is claimed under the appropriate legalbasis, including, without limitation, under 35 U.S.C. § 119(e).

BACKGROUND OF THE INVENTION

Many pathological conditions in the human body may be caused byenlargement, movement, displacement and/or a variety of other changes ofbodily tissue, causing the tissue to press against (or “impinge on”) oneor more otherwise normal tissues or organs. For example, a canceroustumor may press against an adjacent organ and adversely affect thefunctioning and/or the health of that organ. In other cases, bonygrowths (or “bone spurs”), arthritic changes in bone and/or soft tissue,redundant soft tissue, or other hypertrophic bone or soft tissueconditions may impinge on nearby nerve and/or vascular tissues andcompromise functioning of one or more nerves, reduce blood flow througha blood vessel, or both. Other examples of tissues which may grow ormove to press against adjacent tissues include ligaments, tendons,cysts, cartilage, scar tissue, blood vessels, adipose tissue, tumor,hematoma, and inflammatory tissue.

The intervertebral disc 10 is composed of a thick outer ring ofcartilage (annulus fibrosus, 12) and an inner gel-like substance(nucleus pulposus 14). A three-dimensional view of an intervertebraldisc is provided in FIG. 1. The annulus 10 contains collagen fibers thatform concentric lamellae 16 that surround the nucleus and insert intothe endplates of the adjacent vertebral bodies. The nucleus pulposus 14comprises proteoglycans entrapped by a network of collagen and elastinfibers which has the capacity to bind water. When healthy, theintervertebral disc keeps the spine flexible and serves as a shockabsorber by allowing the body to accept and dissipate loads acrossmultiple levels in the spine.

With respect to the spine and intervertebral discs, a variety of medicalconditions can occur in which it is desirable to ultimately surgicallyremove at least some of if not all of an intervertebral disc. As such, avariety of different conditions exist where partial or total discremoval is desirable.

One such condition is disc herniation. Over time, the nucleus pulposusbecomes less fluid and more viscous as a result of age, normal wear andtear, and damage caused from an injury. The proteoglycan and water fromwithin the nucleus decreases which in turn results in the nucleus dryingout and becoming smaller and compressed. Additionally, the annulus tendsto thicken, desiccate, and become more rigid, lessening its ability toelastically deform under load and making it susceptible to discfissures.

A fissure occurs when the fibrous components of the annulus becomeseparated in particular areas, creating a tear within the annulus. Themost common type of fissure is a radial fissure in which the tear isperpendicular to the direction of the fibers. A fissure associated withdisc herniation generally falls into three types of categories: 1)contained disc herniation (also known as contained disc protrusion); 2)extruded disc herniation; and 3) sequestered disc herniation (also knownas a free fragment). In a contained herniation, a portion of the discprotrudes or bulges from a normal boundary of the disc but does notbreach the outer annulus fibrosis. In an extruded herniation, theannulus is disrupted and a segment of the nucleus protrudes/extrudesfrom the disc. However, in this condition, the nucleus within the discremains contiguous with the extruded fragment. With a sequestered discherniation, a nucleus fragment separates from the nucleus and disc.

As the posterior and posterolateral portions of the annulus are mostsusceptible to herniation, in many instances, the nucleus pulposusprogresses into the fissure from the nucleus in a posteriorly orposterolateral direction. Additionally, biochemicals contained withinthe nucleus pulposus may escape through the annulus causing inflammationand irritating adjacent nerves. Symptoms of a herniated disc generallyinclude sharp back or neck pain which radiates into the extremities,numbness, muscle weakness, and in late stages, paralysis, muscle atrophyand bladder and bowel incontinence.

Conservative therapy is the first line of treating a herniated discwhich includes bed rest, medications to reduce inflammation and pain,physical therapy, patient education on proper body mechanics and weightcontrol.

If conservative therapy offers no improvement then surgery isrecommended. Open discectomy is the most common surgical treatment forruptured or herniated discs. The procedure involves an incision in theskin over the spine to remove the herniated disc material so it nolonger presses on the nerves and spinal cord. Before the disc materialis removed, some of the bone from the affected vertebra may be removedusing a laminotomy or laminectomy to allow the surgeon to better see thearea. As an alternative to open surgery, minimally invasive techniqueshave been rapidly replacing open surgery in treating herniated discs.Minimally invasive surgery utilizes small skin incisions, therebyminimizing the damaging effects of large muscle retraction and offeringrapid recovery, less post-operative pain and small incisional scars.

SUMMARY OF THE INVENTION

Aspects of the invention include minimally invasive imaging system.Systems according to embodiments of the invention include: an accessdevice having a proximal end and distal end and an internal passagewayextending from the proximal to distal end; and an elongated memberdimensioned to be slidably moved through the internal passageway of theaccess device and having a proximal and distal end. In the systems ofthe invention, at least one of multiple visualization elements andmultiple illumination elements are positioned among the distal ends ofthe access device and the elongated member. Also provided are methods ofusing the systems in imaging applications, as well as kits forperforming the methods.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 provides a three-dimensional view of an intervertebral discaccording to one embodiment of the invention.

FIG. 2 provides a view of a cross section of the proximal end of asurgical device configured to remove the nucleus pulposus of anintervertebral disc (IVD) according to an embodiment of the invention.

FIG. 3 provides a view of an access device according to an embodiment ofthe invention.

FIG. 4 illustrates a visualization device according to one embodiment ofthe invention viewing the nucleus pulposus of an intervertebral discthrough an access port provided by a access device, such as a retractortube.

FIG. 5 provides a diagrammatic view of the positioning of two imagingsensors to provide a stereoscopic view of an internal target tissuesite.

FIG. 6 provides a schematic representation of the operational frameworkof a processor that may be present in a device according to embodimentsof the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Aspects of the invention include minimally invasive imaging system.Systems according to embodiments of the invention include: an accessdevice having a proximal end and distal end and an internal passagewayextending from the proximal to distal end; and an elongated memberdimensioned to be slidably moved through the internal passageway of theaccess device and having a proximal end and a distal end. In the systemsof the invention, at least one of multiple visualization elements andmultiple illumination elements are positioned among the distal ends ofthe access device and the elongated member. Also provided are methods ofusing the systems in imaging applications, as well as kits forperforming the methods.

Before the present invention is described in greater detail, it is to beunderstood that this invention is not limited to particular embodimentsdescribed, as such may, of course, vary. It is also to be understoodthat the terminology used herein is for the purpose of describingparticular embodiments only, and is not intended to be limiting, sincethe scope of the present invention will be limited only by the appendedclaims.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range, is encompassed within the invention. The upper and lowerlimits of these smaller ranges may independently be included in thesmaller ranges and are also encompassed within the invention, subject toany specifically excluded limit in the stated range. Where the statedrange includes one or both of the limits, ranges excluding either orboth of those included limits are also included in the invention.

Certain ranges are presented herein with numerical values being precededby the term “about.” The term “about” is used herein to provide literalsupport for the exact number that it precedes, as well as a number thatis near to or approximately the number that the term precedes. Indetermining whether a number is near to or approximately a specificallyrecited number, the near or approximating unrecited number may be anumber which, in the context in which it is presented, provides thesubstantial equivalent of the specifically recited number.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can also beused in the practice or testing of the present invention, representativeillustrative methods and materials are now described.

All publications and patents cited in this specification are hereinincorporated by reference as if each individual publication or patentwere specifically and individually indicated to be incorporated byreference and are incorporated herein by reference to disclose anddescribe the methods and/or materials in connection with which thepublications are cited. The citation of any publication is for itsdisclosure prior to the filing date and should not be construed as anadmission that the present invention is not entitled to antedate suchpublication by virtue of prior invention. Further, the dates ofpublication provided may be different from the actual publication dateswhich may need to be independently confirmed.

It is noted that, as used herein and in the appended claims, thesingular forms “a”, “an”, and “the” include plural referents unless thecontext clearly dictates otherwise. It is further noted that the claimsmay be drafted to exclude any optional element. As such, this statementis intended to serve as antecedent basis for use of such exclusiveterminology as “solely,” “only” and the like in connection with therecitation of claim elements, or use of a “negative” limitation.

As will be apparent to those of skill in the art upon reading thisdisclosure, each of the individual embodiments described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinvention. Any recited method can be carried out in the order of eventsrecited or in any other order which is logically possible.

In further describing various aspects of the invention, embodiments ofthe minimally invasive imaging systems and components thereof arereviewed first in greater detail, followed by a review of embodiments ofmethods of using the devices.

Minimally Invasive Imaging Systems

As summarized above, aspects of the invention include minimally invasiveimaging systems. The imaging systems of the invention are minimallyinvasive, such that they may be introduced to an internal target site ofa patient, e.g., a spinal location that is near or inside of anintervertebral disc, through a minimal incision, e.g., one that is lessthan the size of an incision employed for an access device having aouter diameter of 20 mm or larger, e.g., less than 75% the size of suchan incision, such as less than 50% of the size of such an incision, orsmaller.

Imaging systems of the invention include both an access device and anelongate member. The access device is a device having a proximal end anda distal end and an internal passageway extending from the proximal todistal end. Similarly, the elongated member has a proximal end and adistal end and is dimensioned to be slidably moved through the internalpassageway of the access device. Aspects of the invention include atleast one of multiple visualization elements and multiple illuminationelements that are positioned among the distal ends of the access deviceand the elongated member.

Access devices of the invention are elongated elements having aninternal passageway that are configured to provide access to a user(e.g., a health care professional, such as a surgeon) from anextra-corporeal location to an internal target tissue site, e.g., alocation near or in the spine or component thereof, e.g., near or in anintervertebral disc, inside of the disc, etc., through a minimallyinvasive incision. Access devices of the invention may be cannulas,components of retractor tube systems, etc. As the access devices areelongate, they have a length that is 1.5 times or longer than theirwidth, such as 2 times or longer than their width, including 5 or even10 times or longer than their width, e.g., 20 times longer than itswidth, 30 times longer than its width, or longer.

Where the access devices are configured to provide access through aminimally invasive incision, the longest cross-sectional outer dimensionof the access devices (for example, the outer diameter of a tube shapedaccess device, including wall thickness of the access device, which maybe a port or cannula in some instances) ranges in certain instances from5 mm to 50 mm, such as 10 to 20 mm With respect to the internalpassageway, this passage is dimensioned to provide passage of the tools,e.g., imaging devices, tissue modifiers, etc., from an extra-corporealsite to the internal target tissue location. In certain embodiments, thelongest cross-sectional dimension of the internal passageway, e.g., theinner diameter of a tubular shaped access device, ranges in length from5 to 30 mm, such as 5 to 25 mm, including 5 to 20 mm, e.g., 7 to 18 mm.Where desired, the access devices are sufficiently rigid to maintainmechanical separation of tissue, e.g., muscle, and may be fabricatedfrom any convenient material. Materials of interest from which theaccess devices may be fabricated include, but are not limited to:metals, such as stainless steel and other medical grade metallicmaterials, plastics, and the like.

The systems of the invention further include an elongate member having aproximal and distal end, where the elongate member is dimensioned to beslidably moved through the internal passageway of the access device. Asthis component of the systems is elongate, it has a length that is 1.5times or longer than its width, such as 2 times or longer than itswidth, including 5 or even 10 times or longer than its width, e.g., 20times longer than its width, 30 times longer than its width, or longer.When designed for use in IVD procedures, the elongate member isdimensioned to access an intervertebral disc. By “dimensioned to accessan intervertebral disc” is meant that at least the distal end of thedevice has a longest cross-sectional dimension that is 10 mm or less,such as 8 mm or less and including 7 mm or less, where in certainembodiments the longest cross-sectional dimension has a length rangingfrom 5 to 10 mm, such as 6 to 9 mm, and including 6 to 8 mm. Theelongate member may be solid or include one or more lumens, such that itmay be viewed as a catheter. The term “catheter” is employed in itsconventional sense to refer to a hollow, flexible or semi-rigid tubeconfigured to be inserted into a body. Catheters of the invention mayinclude a single lumen, or two or more lumens, e.g., three or morelumens, etc., as desired. Depending on the particular embodiment, theelongate members may be flexible or rigid, and may be fabricated fromany convenient material.

As summarized above, aspects of the invention include at least one ofmultiple visualization elements and multiple illumination elements thatare positioned among the distal ends of the access device and theelongated member. By “at least one of multiple visualization elementsand multiple illumination elements” is meant that, over all, the systemincludes two or more visualization elements and/or two or moreillumination elements that are located among the distal ends of accessdevice and elongated member. Accordingly, embodiments of the systemsinclude those systems where two or more visualization elements arelocated at the distal end of the elongated member. Embodiments of thesystems also include those systems where one visualization element islocated at the distal end of the elongated member and anothervisualization element is located at the distal end of the access device.Furthermore, embodiments of the systems include those systems where twoor more visualization elements are located at the distal end of theaccess device.

Similarly, with respect to the illumination elements, embodiments of thesystems include those systems where two or more illumination elementsare located at the distal end of the elongated member. Embodiments ofthe systems also include those systems where one illumination element islocated at the distal end of the elongated member and anotherillumination element is located at the distal end of the access device.Furthermore, embodiments of the systems include those systems where twoor more illumination elements are located at the distal end of theaccess device.

Accordingly, the phrase “among the distal ends of the access device andelongated member” means that between the two distal ends, there ispositioned at least one of multiple visualization elements and multipleillumination elements. By “located among the distal ends” is meant thatthe item of interest (e.g., the visualization element, the illuminationelement) is present at the distal end of the elongate member and/oraccess device, or near the distal end of the elongate member and/oraccess device, e.g., within 10 mm or closer to the distal end, such aswithin 5 mm or closer to the distal end and including within 3 mm orcloser to the distal end.

Of interest as visualization elements are imaging sensors. Imagingsensors of interest are miniature in size so as to be positionable atthe distal end of the elongate member or the access device. Miniatureimaging sensors of interest are those that, when integrated at thedistal end of an elongated structure along with an illumination source,e.g., such as an LED as reviewed below, can be positioned on a probehaving a longest cross section dimension of 6 mm or less, such as 5 mmor less, including 4 mm or less, and even 3 mm or less. In certainembodiments, the miniature imaging sensors have a longest cross-sectiondimension (such as a diagonal dimension) of 5 mm or less, such 3 mm orless, where in certain instances the sensors may have a longestcross-sectional dimension ranging from 2 to 3 mm. In certainembodiments, the miniature imaging sensors have a cross-sectional areathat is sufficiently small for its intended use and yet retain asufficiently high matrix resolution. Certain imaging sensors of theinvention have a cross-sectional area (i.e. an x-y dimension, also knownas packaged chip size) that is 2 mm 2 mm or less, such as 1.8 mm 1.8 mmor less, and yet have a matrix resolution of 400 400 or greater, such as640 480 or greater. In some instances, the imaging sensors have asensitivity that is 500 mV/Lux-sec or greater, such as 700 mV/Lux-Sec orgreater, including 1000 mV/Lux-Sec or greater, where in some instancesthe sensitivity of the sensor is 2000 mV/Lux-Sec or greater, such as3000 mV/Lux-Sec or greater. The imaging sensors of interest are thosethat include a photosensitive component, e.g., array of photosensitiveelements, coupled to an integrated circuit, where the integrated circuitis configured to obtain and integrate the signals from thephotosensitive array and output the analog data to a backend processor.The image sensors of interest may be viewed as integrated circuit imagesensors, and include complementary metal-oxide-semiconductor (CMOS)sensors and charge-coupled device (CCD) sensors. The image sensors mayfurther include a lens positioned relative to the photosensitivecomponent so as to focus images on the photosensitive component. Asignal conductor may be present to connect the image sensor at thedistal and to a device at the proximal end of the elongate member, e.g.,in the form of one or more wires running along the length of theelongate member from the distal to the proximal end. Imaging sensors ofinterest include, but are not limited to, those obtainable from:OminVision Technologies Inc., Sony Corporation, Cypress Semiconductors.The imaging sensors may be integrated with the component of interest,e.g., the access device or the elongated structure. As the imagingsensor(s) is integrated at the distal end of the component, it cannot beremoved from the remainder of the component without significantlycompromising the structure of component. As such, the integratedvisualization element is not readily removable from the remainder of thecomponent, such that the visualization element and remainder of thecomponent form an inter-related whole.

While any convenient imaging sensor may be employed in devices of theinvention, in certain instances the imaging sensor is a CMOS sensor. Ofinterest as CMOS sensors are the OmniPixel line of CMOS sensorsavailable from OmniVision (Sunnyvale, Calif.), including the OmniPixel,OmniPixel2, OmniPixel3, OmniPixel3-HS and OmniBSI lines of CMOS sensors.These sensors may be either frontside or backside illumination sensors,and have sufficiently small dimensions while maintaining sufficientfunctionality to be positioned at the distal end of the minimallyinvasive devices of the invention. Aspects of these sensors are furtherdescribed in one or more the following U.S. patents, the disclosures ofwhich are herein incorporated by reference: U.S. Pat. Nos. 7,388,242;7,368,772; 7,355,228; 7,345,330; 7,344,910; 7,268,335; 7,209,601;7,196,314; 7,193,198; 7,161,130; and 7,154,137.

A variety of different types of lights sources may be employed asillumination elements, so long as their dimensions are such that theycan be positioned at the distal end of the access device and/orelongated member. The light sources may be integrated with a givencomponent (e.g., access device, elongated member) such that they areconfigured relative to the component such that the light source elementcannot be removed from the remainder of the component withoutsignificantly compromising the structure of the component. As such, theintegrated illumination element of these embodiments is not readilyremovable from the remainder of the component, such that theillumination element and remainder of the component form aninter-related whole. The light sources may be light emitting diodesconfigured to emit light of the desired wavelength range, or opticalconveyance elements, e.g., optical fibers, configured to convey light ofthe desired wavelength range from a location other than the distal endof the elongate member, e.g., a location at the proximal end of theelongate member, to the distal end of the elongate member. As with theimage sensors, the light sources may include a conductive element, e.g.,wire, optical fiber, which runs the length of the elongate member toprovide for control of the light sources from a location outside thebody, e.g., an extracorporeal control device. Where desired, the lightsources may include a diffusion element to provide for uniformillumination of the target tissue site. Any convenient diffusion elementmay be employed, including but not limited to a translucent cover orlayer (fabricated from any convenient translucent material) throughwhich light from the light source passes and is thus diffused. In thoseembodiments of the invention where the system includes two or moreillumination elements, the illumination elements may emit light of thesame wavelength or they may be spectrally distinct light sources, whereby “spectrally distinct” is meant that the light sources emit light atwavelengths that do not substantially overlap, such as white light andinfra-red light, such as the spectrally distinct light sources describedin copending U.S. application Ser. No. 12/269,772 titled “MinimallyInvasive Imaging Device” filed on even date herewith; the disclosure ofwhich is herein incorporated by reference. In certain embodiments, theelongate member of the system further includes a tissue modifier. Tissuemodifiers are components or sub-devices that interact with tissue insome manner to modify the tissue in a desired way. The term modify isused broadly to refer to changing in some way, including cutting thetissue, ablating the tissue, delivering an agent(s) to the tissue,freezing the tissue, etc. As such, of interest as tissue modifiers aretissue cutters, tissue ablators, tissue freezing/heating elements, agentdelivery devices, etc. Tissue cutters of interest include, but are notlimited to: blades, liquid jet devices, lasers and the like. Tissueablators of interest include, but are not limited to ablation devices,such as devices for delivery ultrasonic energy (e.g., as employed inultrasonic ablation), devices for delivering plasma energy, devices fordelivery radiofrequency (RF) energy, devices for delivering microwaveenergy, etc. Energy transfer devices of interest include, but are notlimited to: devices for modulating the temperature of tissue, e.g.,freezing or heating devices, etc.

In certain embodiments, the elongated member may further include one ormore lumens that run at least the substantial length of the device,e.g., for performing a variety of different functions. In certainembodiments where it is desired to flush (i.e., wash) the location ofthe target tissue at the distal end of the elongate member (e.g., toremove cut tissue from the location, etc.), the elongated member mayinclude both an irrigation and aspiration lumen. During use, theirrigation lumen is operatively connected to a fluid source (e.g.,physiologically acceptable fluid, such as saline) at the proximal end ofthe device, where the fluid source is configured to introduce fluid intothe lumen under positive pressure, e.g., at a pressure ranging from 0 to500 mm Hg, so that fluid is conveyed along the irrigation lumen and outthe distal end. While the dimensions of the irrigating lumen may vary,in certain embodiments the longest cross-sectional dimension of theirrigation lumen ranges from 1 to 3 mm. During use, the aspiration lumenis operatively connected to a source of negative pressure (e.g., vacuumsource) at the proximal end of the device, where the negative pressuresource is configured to draw fluid from the tissue location at thedistal end into the irrigation lumen under positive pressure, e.g., at apressure ranging from 50 to 600 mm Hg, so that fluid is removed from thetissue site and conveyed along the irrigation lumen and out the proximalend, e.g., into a waste reservoir. While the dimensions of theaspiration lumen may vary, in certain embodiments the longestcross-sectional dimension of the aspiration lumen ranges from 1 to 4 mm,such as 1 to 3 mm.

In certain embodiments, the systems of the invention are used inconjunction with a controller configured to control illumination of theillumination elements and/or capture of images (e.g., as still imaged orvideo output) from the image sensors. This controller may take a varietyof different formats, including hardware, software and combinationsthereof. The controller may be physically located relative to theelongated member and/or access device at any convenient location, wherethe controller may be present at the distal end of the systemcomponents, at some point between the distal and proximal ends or at theproximal ends of the system components, as desired. In certainembodiments, the controller may be distinct from the system components,i.e., access device and elongated member, such the access device and/orelongated member includes a controller interface for operativelycoupling to the distinct controller, or the controller may be integralwith the device.

FIG. 2 provides a cross-sectional view of the distal ends of theelongated member and access device of a system according to oneembodiment of the invention, where the system is configured to beemployed in the surgical removal of the nucleus pulposus of anintervertebral disc. In FIG. 2, distal end of elongated member 20 (inthis embodiment a catheter) includes first imaging sensor 21 whiledistal end of access device 22 includes a second imaging sensor 23. Alsoshown at the distal end of elongated member 20 are first and secondLEDs, 24 and 25. Also shown is an irrigation lumen 26 and aspirationlumen 27. In addition, the device includes a tissue modifier in the formof a dissection electrode 28. In the system shown in FIG. 2, the firstimaging sensor 21 provides visualization of the target tissue site. Thesecond imaging sensor 23 is positioned on the access device (although itcould be positioned at a variety of locations on the access device orthe elongated member). The orientation of second imaging sensor 23 issuch that imaging sensor 23 provides imaged data of the elongatedmember, e.g., of the distal end of the elongated member duringplacement, etc. Any convenient positioning as use may be achieved.

FIG. 3 provides different views of an access device according to anembodiment of the invention. As shown in FIG. 3, access device 30includes a distal end 31. Positioned at distal end 31 are two cameras32A and 32B and two illumination sources, e.g., LEDs or light fibers,33A and 33B. Running the length of the access device and exiting theproximal end are wires 34 and 35 for provide power and control to thecameras and visualization elements, e.g., via coupling to a controldevice.

The multiple visualization and/or illumination elements of the devicesmay be positioned relative to each other in a variety of different ways.By selective positioning of these elements coupled, as desired, withspecific image data processing techniques, unique views of the targettissue site may be obtained. For example, as illustrated in FIG. 4, twocameras 42 and 44 may be positioned in the same cross-section of thedistal end of the imaging device. Image data from the two cameras can,in such an embodiment, be combined to obtain a panoramic view of thetarget tissue site, in this case the nucleus pulposus. Thisconfiguration also allows one to obtain a stereoscopic view of thetarget tissue site, as illustrated in FIG. 5, e.g., by synchronizing theimage data from the two cameras. As illustrated in FIG. 5, by imageprocessing the depth of the circle object can be distinguished from thesquare object. For embodiments where stereovision is desired, the ratioof object distance (i.e., distance of object of interest from thecamera) to stereo baseline (i.e., camera to camera distance) may vary,and in certain instances ranges from 10 to 30, such as 15 to 25, e.g.,20 (e.g., where the object depth is 20 mm and the two cameras are 1 mmapart).

Placement of the visualization elements in different cross sections ofthe devices and/or on different devices can also provide for advantagesin imaging. For example, FIG. 2 provides an illustration of a distal endof a system made up of a catheter visualization device slidablypositioned within an internal passageway of an access device, such as aretractor tube. In the embodiment depicted in FIG. 2, the primary camera21 is on the cross section of the catheter, and the secondary camera 23is on the wall of the access device. Both cameras can be arranged tohave certain orientations, as desired, such as forward viewing or angledor side viewing. Illuminations can also be arranged such that differentviews of the same object can be revealed. For example, the light sourcecan be somewhat collimated or focused in a certain direction to give abetter view of the surgical blades, electrodes or the local tissueappearance.

The devices or components thereof may be configured for one time use(i.e., disposable) or re-usable, e.g., where the components areconfigured to be used two or more times before disposal, e.g., where thedevice components are sterilizable.

Methods

Aspects of the invention further include methods of imaging an internaltissue site with imaging devices of the invention. A variety of internaltissue sites can be imaged with devices of the invention. In certainembodiments, the methods are methods of imaging an intervertebral discin a minimally invasive manner. For ease of description, the methods arenow primarily described further in terms of imaging IVD target tissuesites. However, the invention is not so limited, as the devices may beused to image a variety of distinct target tissue sites.

With respect to imaging an intervertebral disc or portion thereof, e.g.,exterior of the disc, nucleus pulposus, etc., embodiments of suchmethods include positioning a distal end of a minimally invasiveintervertebral disc imaging device of the invention in viewingrelationship to an intervertebral disc or portion of there, e.g.,nucleus pulposus, internal site of nucleus pulposus, etc. By viewingrelationship is meant that the distal end is positioned within 40 mm,such as within 10 mm, of the target tissue site of interest. Positioningthe distal end in viewing device in relation to the desired targettissue may be accomplished using any convenient approach, includingthrough use of an access device, such as a cannula or retractor tube,which may or may not be fitted with a trocar, as desired. Followingpositioning of the distal end of the imaging device in viewingrelationship to the target tissue, the target tissue, e.g.,intervertebral disc or portion thereof, is imaged through use of theillumination and visualization elements to obtain image data. Image dataobtained according to the methods of the invention is output to a userin the form of an image, e.g., using a monitor or other convenientmedium as a display means. In certain embodiments, the image is a stillimage, while in other embodiments the image may be a video.

In certain embodiments, the methods include a step of tissuemodification in addition to the tissue viewing. For example, the methodsmay include a step of tissue removal, e.g., using a combination oftissue cutting and irrigation or flushing. For example, the methods mayinclude cutting a least a portion of the tissue and then removing thecut tissue from the site, e.g., by flushing at least a portion of theimaged tissue location using a fluid introduce by an irrigation lumenand removed by an aspiration lumen.

FIG. 4 provides a view of one embodiment of a method of visualizing anintervertebral disc. In the embodiment illustrated in FIG. 4, an accessdevice, e.g., cannula, trocar, etc. is employed to provide access of thedevice to the internal body site, e.g., via a minimally sized incision.FIG. 4 shows a visualization device according to an embodiment of theinvention viewing the nucleus pulposus of an intervertebral disc throughan access port provided by an access device, such as a cannula. In FIG.4, the visualization elements are positioned at the distal end of acatheter member, and are located in the same cross-sectional plane.Image data from the two visualization elements may be obtained andprocessed to provide for an enhanced field of view, e.g., a panoramicview, where the enhanced field of view may be one that is wider than theview obtained from a signal visualization element and/or provide forstereoscopic view, as illustrated in FIG. 5.

FIG. 6 provides a flow chart representation of a stereoscopic imageprocessing algorithm according to an embodiment of the invention, wherethe algorithm is configured to derived depth or “range” map on atwo-dimensional scene. In the process depicted in FIG. 6, left and rightimages 61 a and 61 b obtained by two distinct visualization elements,e.g., sensors 42 and 44 as depicted in FIG. 5, are first warped as shownat 62 a and 62 b via calibration element 63 to remove lens distortion.The resultant undistorted left and right images 64 a and 64 b are thenprocessed with stereo and image fusion algorithms 65 and 66 to derive adisparity line 67. Finally, triangulation computations 68 are applied toderive range data. The range (or depth) map 69 can be overlay on theimage display, as desired.

Methods of invention may find use in any convenient application,including diagnostic and therapeutic applications. Specific applicationsof interest include, but are not limited to, intervertebral discdiagnostic and therapeutic applications. For example, methods of theinvention include diagnostic applications, where a disc is viewed todetermine any problems with the disc, if present. Methods of theinvention also include treatment methods, e.g., where a disc is modifiedin some manner to treat and existing medical condition. Treatmentmethods of interest include, but are not limited to: annulotomy,nucleotomy, discectomy, annulus replacement, nucleus replacement, anddecompression due to a bulging or extruded disc. Additional methods inwhich the imaging devices find use include those described in UnitedStates Published Application No. 20080255563.

Methods and devices of the invention may be employed with a variety ofsubjects. In certain embodiments, the subject is an animal, where incertain embodiments the animal is a “mammal” or “mammalian.” The termsmammal and mammalian are used broadly to describe organisms which arewithin the class mammalia, including the orders carnivore (e.g., dogsand cats), rodentia (e.g., mice, guinea pigs, and rats), lagomorpha(e.g. rabbits) and primates (e.g., humans, chimpanzees, and monkeys). Incertain embodiments, the subjects (i.e., patients) are humans.

Kits

Also provided are kits for use in practicing the subject methods, wherethe kits may include one or more of the above devices, and/or componentsof the subject systems, as described above. As such, a kit may include avisualization device and an access device, e.g., a cannula configured tobe employed with the visualization device. The kit may further includeother components, e.g., guidewires, stylets, etc., which may find use inpracticing the subject methods. Various components may be packaged asdesired, e.g., together or separately.

In addition to above mentioned components, the subject kits may furtherinclude instructions for using the components of the kit to practice thesubject methods. The instructions for practicing the subject methods aregenerally recorded on a suitable recording medium. For example, theinstructions may be printed on a substrate, such as paper or plastic,etc. As such, the instructions may be present in the kits as a packageinsert, in the labeling of the container of the kit or componentsthereof (i.e., associated with the packaging or subpackaging) etc. Inother embodiments, the instructions are present as an electronic storagedata file present on a suitable computer readable storage medium, e.g.CD-ROM, diskette, etc. In yet other embodiments, the actual instructionsare not present in the kit, but means for obtaining the instructionsfrom a remote source, e.g. via the internet, are provided. An example ofthis embodiment is a kit that includes a web address where theinstructions can be viewed and/or from which the instructions can bedownloaded. As with the instructions, this means for obtaining theinstructions is recorded on a suitable substrate.

Computer Readable Storage Media

Also of interest is programming that is configured for operating avisualization device according to methods of invention, where theprogramming is recorded on physical computer readable media, e.g. anymedium that can be read and accessed directly by a computer. Such mediainclude, but are not limited to: magnetic storage media, such as floppydiscs, hard disc storage medium, and magnetic tape; optical storagemedia such as CD-ROM; electrical storage media such as RAM and ROM; andhybrids of these categories such as magnetic/optical storage media. Oneof skill in the art can readily appreciate how any of the presentlyknown computer readable mediums can be used to create a manufacturecomprising a storage medium having instructions for operating aminimally invasive in accordance with the invention.

Programming of the invention includes instructions for operating adevice of the invention, such that upon execution by the programming,the executed instructions result in execution of the imaging device to:illuminate a target tissue site, such as an intervertebral disc orportion thereof; and capture one or more image frames of the illuminatedtarget tissue site with the imaging sensor.

All publications and patent applications cited in this specification areherein incorporated by reference as if each individual publication orpatent application were specifically and individually indicated to beincorporated by reference. The citation of any publication is for itsdisclosure prior to the filing date and should not be construed as anadmission that the present invention is not entitled to antedate suchpublication by virtue of prior invention.

Although the foregoing invention has been described in some detail byway of illustration and example for purposes of clarity ofunderstanding, it is readily apparent to those of ordinary skill in theart in light of the teachings of this invention that certain changes andmodifications may be made thereto, without departing from the spirit orscope of the appended claims.

1. A minimally invasive imaging system, the imaging system comprising:(a) an access device having a proximal end and distal end and aninternal passageway extending from the proximal end to the distal end;and (b) an elongated member dimensioned to be slidably moved through theinternal passageway of the access device and having a proximal anddistal end; wherein at least one of multiple visualization elements andmultiple illumination elements are positioned among the distal ends ofthe access device and the elongated member.
 2. The minimally invasiveimaging system according to claim 1, wherein multiple visualizationelements are positioned among the distal ends of the access device andthe elongated member.
 3. The minimally invasive imaging system accordingto claim 2, wherein the multiple visualization elements are positionedat the distal end of the elongated member.
 4. The minimally invasiveimaging system according to claim 3, wherein the multiple visualizationelements are positioned to provide for at least one of enhanced field ofview and stereoscopic view.
 5. The minimally invasive imaging systemaccording to claim 2, wherein the multiple visualization elements arepositioned at the distal end of the access device.
 6. The minimallyinvasive imaging system according to claim 2, wherein a firstvisualization element is positioned at the distal end of the elongatedmember and a second visualization element is positioned at the distalend of the access device.
 7. The minimally invasive imaging systemaccording to claim 1, wherein multiple illumination elements arepositioned among the distal ends of the access device and the member. 8.The minimally invasive imaging system according to claim 7, whereinmultiple illumination elements are positioned at the distal end of theelongated member.
 9. The minimally invasive imaging system according toclaim 7, wherein multiple illumination elements are positioned at thedistal end of the access device.
 10. The minimally invasive imagingsystem according to claim 1, wherein the visualization elements areselected from CCO and CMOS sensors.
 11. The minimally invasive imagingsystem according to claim 1, wherein the illumination elements are lightemitting diodes.
 12. The minimally invasive imaging system according toclaim 1, wherein the elongated member further comprises a tissuemodifier.
 13. The minimally invasive imaging system according to claim1, wherein the tissue modifier is chosen from an electrode, cuttingelement and laser.
 14. The minimally invasive imaging system accordingto claim 1, wherein the elongate member further includes an irrigationlumen and an aspiration lumen.
 15. A method of imaging an internaltarget tissue of a patient, the method comprising: (a) positioning aminimally invasive access device having a proximal end and distal endand an internal passageway so that the distal end is near the target 30tissue; and (b) slidably moving an elongated member having a proximaland distal end through the internal passageway of the access device sothat the distal end of the elongated member is operably positionedrelative to the target tissue; wherein at least one of multiplevisualization elements and multiple illumination elements are positionedamong the distal ends of the access port and the elongated member; (c)illuminating the target tissue with at least one of the multipleillumination elements; and (d) obtaining image data of the target tissuewith at least one of the visualization elements.
 16. The methodaccording to claim 15, wherein multiple visualization elements arepositioned among the distal ends of the access device and the elongatedmember.
 17. The method according to claim 16, wherein the multiplevisualization elements are positioned at the distal end of the elongatedmember.
 18. The method according to claim 17, wherein the multiplevisualization elements are positioned to provide for at least one ofenhanced field of view and stereoscopic view and the method comprisesobtaining at least one of an enhanced field of view and a stereoscopicview.
 19. The method according to claim 16, wherein the multiplevisualization elements are positioned at the distal end of the accessdevice.
 20. The method according to claim 16, wherein a firstvisualization element is positioned at the distal end of the elongatedmember and a second visualization element is positioned at the distalend of the access device. 21-48. (canceled)